April 20, 2020 | Today’s News

A Message From the AAOS President

In his most recent presidential update, AAOS President Joseph A. Bosco III, MD, FAAOS, shared the Academy’s recommendations on resuming elective surgery. He emphasized that factors such as resource availability, disease burden, stage of pandemic, and legal restrictions vary by location. Once it is decided to return to elective surgery, four vital issues that must be addressed are: (1) velocity of return, (2) location of return, (3) prioritization of surgical cases, and (4) COVID-19 testing for patients and staff. Dr. Bosco also addresses the five principles guiding velocity of return: (1) resource availability, (2) using “COVID-19-free” hospitals and ambulatory surgery centers when possible, (3) ambulatory cases first, (4) inpatient cases American Society of Anesthesiologists (ASA) grades I and II, and (5) ASA grades III and IV. Dr. Bosco concluded, “Your Academy, through its advocacy efforts, continues to work to ensure that you get the relief you deserve to maintain practice solvency and retain employees. We remain completely aligned in all our efforts on behalf of our patients and our profession. I am convinced that, together, we will all emerge stronger and better for it.”

Read Dr. Bosco’s message…

The Centers for Medicare & Medicaid Services (CMS) issued guidelines for healthcare systems to reopen in areas in phase 1 of President Donald J. Trump’s Guidelines for Opening Up America Again, which are areas with low incidence or relatively low and stable incidence of COVID-19 cases that have adequate testing, staffing, and facility resources. These areas must first pass gating criteria regarding symptoms, cases, and hospitals The recommendations also include resuming elective surgery on a limited basis in areas in phase 1.

Read the CMS press release…

Read the guidelines…

Study Assesses Relationship Between COPD and VTE in TKA

According to a study published online in The Journal of Arthroplasty, patients with chronic obstructive pulmonary disease (COPD) had a greater risk of developing venous thromboemboli (VTEs) following total knee arthroplasty (TKA). Primary TKA patients with COPD (n = 176,148) were matched 1:5 to control patients (n = 35,230) by age, sex, and medical comorbidities. Outcomes included hospital length of stay (LOS), readmission rates, VTEs, and costs of care. Hospital LOS was longer for COPD patients (four days versus three days); they also had higher rates and odds of readmission and VTEs. COPD patients had higher 90-day episode of care costs ($15,626.85 versus $14,471.29).

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A study published in the April issue of The American Journal of Sports Medicine (AJSM) evaluated the relationship between alternative web-based metrics (altmetrics) and traditional bibliometrics and determined which publication characteristics are predictive of higher altmetric scores. The following journals were queried for articles published during 2016: AJSM; The Journal of Bone & Joint Surgery; Clinical Orthopaedics and Related Research; Acta Orthopaedica; and Knee Surgery, Sports Traumatology, Arthroscopy. Data collection included journal; geographic region of origin; highest degree of first author; study subject and design; sample size; conflicts of interest; level of evidence; number of authors, references, institutions, citations, tweets, Facebook mentions, and news mentions; and Altmetric Attention Score (AAS). Final analysis included 496 published articles with a mean AAS of 8.6 and mean citation rate of 15.0. Factors predictive of higher AAS were articles published in AJSM, publications in North America, and studies concerning measure validation/reliability. An association was observed between greater AAS score and greater citation rate; citation rate independently predicted greater social media attention on Twitter, Facebook, and the news.

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A systematic review and meta-analysis published in the April issue of the European Spine Journal compared breach rates and screw-related complications in adolescent idiopathic scoliosis (AIS) patients undergoing spine surgery with pedicle screws with freehand screw insertion versus image guidance methods. The study authors queried the Embase, Medline, CINAHL, CENTRAL, and Web of Science databases and located 94 relevant studies, of which 18 were of moderate risk bias or better. Two head-to-head studies presenting moderate evidence found that CT guidance had lower breach rates than freehand methods; no complications were reported in either study. Individual studies with moderate evidence also found lower breach rates for image guidance versus freehand but with conflicting complication rates. Image guidance had longer operative time than freehand (moderate evidence; 257.7 minutes versus 226.8 minutes).

Read the abstract…

2020 ABOS WLA Is Underway: What You Need to Know

On Jan. 2, the American Board of Orthopaedic Surgery (ABOS) posted 152 Knowledge Sources to each Diplomate’s ABOS Web-Based Longitudinal Assessment (WLA) portal. They included 51 of the top sources from the 2019 ABOS WLA Program administration and 101 new Knowledge Sources for this year. Diplomates who are interested in participating in the 2020 ABOS WLA Program should start reviewing and choosing their Knowledge Sources now. This year’s Assessment Window is April 13 to May 18.

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AAOS Board of Directors Approves Endorsement of Four AAHKS CPGs of Anesthesia and Analgesia in TJA

The AAOS Board of Directors has endorsed the first four of eight clinical practice guidelines (CPG) produced by the American Association of Hip and Knee Surgeons (AAHKS) in collaboration with AAOS, the American Society of Regional Anesthesia and Pain Medicine, The Hip Society, and The Knee Society on perioperative analgesia and anesthesia following hip and knee arthroplasty. This first section covered acetaminophens, gabapentinoids, and nonsteroidal anti-inflammatory drugs, classic oral medications used following total joint arthroplasty (TJA).

View the guidelines…